Endoscopy 2019; 51(04): S78
DOI: 10.1055/s-0039-1681399
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: ESD esophagus Congress Hall
Georg Thieme Verlag KG Stuttgart · New York

OUTCOMES OF ESOPHAGECTOMY FOR PATIENTS AFTER NON-CURATIVE ENDOSCOPIC RESECTION OF EARLY ESOPHAGEAL CANCER

M Barret
1   Gastroenterology, Cochin Hospital, Paris, France
,
S Dermine
1   Gastroenterology, Cochin Hospital, Paris, France
,
M Leconte
2   Digestive Surgery, Cochin Hospital, Paris, France
,
S Leblanc
1   Gastroenterology, Cochin Hospital, Paris, France
,
A Berger
3   Gastroenterology, Georges Pompidou European Hospital, Paris, France
,
G Rahmi
3   Gastroenterology, Georges Pompidou European Hospital, Paris, France
,
M Pioche
4   Gastroenterology, Edouard Herriot University Hospital, Lyon, France
,
JM Canard
5   Gastroenterology, Trocadero Private hospital, Paris, France
,
V Lepilliez
6   Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
,
O Plomteux
7   Gastroenterology, CHC Private Hospital, Liege, Belgium
,
F Prat
1   Gastroenterology, Cochin Hospital, Paris, France
,
S Chaussade
1   Gastroenterology, Cochin Hospital, Paris, France
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

To analyze the oncological outcomes and the safety of esophagectomy after non curative endoscopic resection of a superficial esophageal cancer.

Methods:

A retrospective review from 2012 to 2018 was performed at four French tertiary referral centers. All patients had a non-curative endoscopic resection followed by esophagectomy after a multidisciplinary meeting decision. Outcomes measurements were the rates T0N0 specimens, postoperative morbidity and mortality, and overall, disease-free, and cancer specific survival.

Results:

Thirty patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) with a median age of 65 years were included. The reasons of non-curative endoscopic resection were: positive vertical margins (n = 12), squamous cell carcinoma invading the muscularis mucosae (m3) or the submucosal layer (n = 3 and 9 respectively), adenocarcinoma with a deep submucosal invasion (n = 10), poor differentiation (n = 6) and lymphovascular invasion (n = 6). Two patients had lymph node involvement, and 10 had residual cancer on the surgical resection specimen. Overall, 63% of the esophagi were T0N0. Half of the patients had one or more severe post-operative complication according to the Clavien-Dindo classification: IIIa (n = 3), IIIb (n = 4), IVa (n = 6) and V (n = 2). We diagnosed 2 distant recurrences during a median follow-up of 24 months. At the end of the follow-up, overall, disease-free and cancer specific-survival were 83.3%, 75%, and 90% respectively.

Conclusions:

Esophagectomy after non-curative endoscopic resection of esophageal cancers allowed to resect residual cancer in 30% and lymph node metastases in 7% of cases, at the cost of 43% severe morbidity and 7% peri-operative mortality. Esophagectomy in this setting has comparable morbidity and mortality to that of esophagectomy for larger tumors. Therefore, the risk of lymph node involvement of early esophageal cancer, as well as the possibility of chemoradiation therapy or close follow-up needs to be assessed in multidisciplinary meetings before indicating esophagectomy after endoscopic resection.